Table 4 Primary and secondary study outcomes and accompanying measurement tool for each study variable and participant

Anthropometric Variables. Assessment of body composition includes height (by stadiometer), weight (by digital scale), body mass index (BMI, defined as weight in kg/height in meters squared). Participants are asked to remove their shoes and any heavy outer clothing prior to measurement to avoid error. A total of three measures are taken at each data collection point and then an average of these three are used for the analysis.

Variables: Height. Weight, BMI, waist circumference

Participant: Child

Time: 5 mins

Healthy Kids Checklist. This instrument is a 32-item rating scale that measures nutrition behaviors and physical activity habits at home of both parent and child. It also evaluates parental role modeling of healthy lifestyle practices. The Checklist is targeted at children in preschool in low-income areas served by the USDA food program. The parent serves as a reporter for a child’s lifestyle (physical activity, sleeping habits, etc.) and eating behaviors. This scale is comprised of three domains consisting of 12 determinants that should be included in a pediatric obesity risk assessment tool: 1) Diet domain includes eight determinants: fat, fiber, fruit/vegetable intake, calcium/dairy intake, sweetened beverages, eating in restaurants, breakfast skipping, energy density; 2) Lifestyle domain includes three determinants: physical activity, sleep duration, television viewing. 3) For the Parenting domain, role modeling is determined. Parent-report of child physical activity also includes TV viewing. In addition, it utilizes low-literacy, pictorially representing items and has been validated for this population of low income families.

Variables: Child and Parent Home Diet, Home Lifestyle, Parenting, Role Modeling

Respondent: Parent proxy

Time: 10 mins

Willett Semiquantative Food Frequency Questionnaire. To measure changes in food items served to children by the childcare centers, a food frequency questionnaire has been adapted from the Willett Semiquantative Food Frequency Questionnaire (1998). This will be completed by the owner of the facility about types of foods offered. The survey is available in English and Spanish and is a reliable and valid measure. Owners are asked to provide a copy of the invoice of food ordered that month along with the questionnaire.

Variable: Childcare Center Diet

Respondent: Center Director proxy

Time: 5 mins

MATERNAL and CHILDCARE PROVIDER MEASURES

DOMAINS

Descriptive Information. A comprehensive survey has been previously developed that includes demographic questions such as age of the child and respondent; perceptions regarding the weight of the child as well as the respondent; perceived health status; country of origin of the child and respondent; language spoken in the home; food consumption patterns; acculturation questions related to food purchases and preferences; and food insecurity will be implemented. This survey has been adapted using valid measures and is culturally appropriate for the Miami-Dade community based on ethnicity.

Variables: Food insecurity, Acculturation

Respondent: Parent, Teacher

Time: 15 mins

Food Behavior Checklist (FBC) . A 16-item self-report measure of parent and teacher dietary intake, this tool includes seven fruit/vegetable, two milk/dairy, one food security, three diet quality and three fat/cholesterol items. With a sample of low-income clients from eight counties participating in EFNEP and FSNE, authors reported a criterion validity coefficient (r =.43) with a biomarker, serum carotenoids, for the fruit and vegetable sub-scale. Convergent validity was reported for 10 selected nutrients and the Healthy Eating Index for the 16-item tool. Compared with the 24-hour dietary recall, it is less time-consuming to administer and analyze, with a reduced respondent burden. Responses to nineteen food behaviour items were significantly correlated with hypothesized 24 h recall data (with a maximum correlation of 0·44 for drinking milk and calcium) or the USDA HFSSM (0·42 with the food security item). Coefficients for test–retest reliability ranged from 0·35 to 0·79. Cronbach’s α ranged from 0·49 for the diet quality sub-scale to 0·80 for the fruit and vegetable sub-scale.

Variables: Diet and Lifestyle (planning and fixing food)

Respondent: Parent, Teacher

Time: 10 mins

Physical Activity Self-Efficacy Scale. This five-item questionnaire–measures confidence regarding participation in physical activity such as overcoming barriers to exercise including negative affect, relapse, lack of time, and environmental conditions. The measure utilizes an 11-point scale ranging from “not at all confident” to “very confident”. Test-retest (product moment) reliability over a two-week period was .90. The instrument has also demonstrated adequate concurrent validity with stages-of-change measures.

Variables: Self-efficacy for being physically active

Respondent: Parent, Teacher

Time: 5 mins

CLASSROOM ENVIRONMENT

Lesson Plan Review of Physical Activity . Classroom schedules and lesson plans will be reviewed to measure time spent in physical activity. This information will assist with determining fidelity to the treatment model. Data will be collected by trained RAs utilized the tool developed in our pilot study and include items such as amount of time spent in outdoor play, amount of time spent watching TV, etc.

Variables: Classroom physical activity environment

Respondent: Observe

Behavior Observation of Classroom . Data will be collected by trained RAs on foods and drinks served in the classroom. This will consist of observing breakfast, lunch, and snack and will determine fidelity to the treatment intervention (i.e. Children are included in preparation of meals as much as possible, staff serve as healthy role models, canned fruits are low in sugar and drained before being served). We have successfully implemented this tool in both our HI HO and HC2 projects.

Variables: Classroom nutrition environment

Respondent: Observation